BPJS Health Encourages Hospitals to Submit Complete Covid Claim Files


Suara.com – From January 2021 to October 2021, BPJS Kesehatan received a total of 1,345,970 cases of Covid-19 claims submitted by hospitals with a total cost of Rp72.3 trillion. After passing the verification carried out by BPJS Kesehatan, the result was that 1,180,858 Covid-19 cases with a total cost of Rp. 64.1 trillion passed the verification. This was stated by the Managing Director of BPJS Kesehatan, Ali Ghufron Mukti in a webinar organized by the Indonesian Hospital Association (PERSI) East Java, Tuesday (12/10).

“For Covid-19 claims in 2020 BPJS Kesehatan has received 686,129 claims submitted at a cost of Rp. 40.7 trillion. Almost all of them have been verified. Meanwhile, until October 11, 2021, we have verified around 87.7% of Covid-19 claims,” ​​said Ghufron.

From the results of the verification of Covid-19 claims in 2021, there were 79,07% appropriate claims as many as 933,708 cases with a cost of IDR 50.5 trillion, 14.42% of disputed claims with 170,335 cases with a cost of IDR 9.9 trillion, 6.12% of pending claims as many as 72,248 cases with a cost of Rp 3.4 trillion, and 0.39% are claims that have expired or are not in accordance with the provisions as many as 4,567 cases with a cost of Rp 193 billion.

“The process carried out by BPJS Health, starting from the receipt of documents until the verification results are obtained, must be completed within 14 working days from the time the claim file is received by BPJS Health. If the claim is appropriate, then the claim will be paid by the Indonesian Ministry of Health (Kemenkes),” he explained.

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Ghufron also explained that a pending claim occurs when the claim file submitted by the hospital is incomplete, while a dispute claim occurs if from the results of the verification of the claim submitted by the hospital there is a discrepancy or disagreement regarding the service or clinical action so that it must be resolved by the Indonesian Ministry of Health through the team. Settlement of Dispute Claims in the area. Ghufron again reminded that claims from January to October 2021 can be submitted by hospitals starting June 1, 2021 until no later than December 31, 2021. Meanwhile, claims for November 2021 and so on, must be submitted no later than two months after the hospital provides health services to patients. Covid-19.

“If the claim is submitted past the time limit as stated in the provisions, it will become an expired claim. We have provided a Covid-19 claim monitoring dashboard that can be accessed by the hospital. Therefore, we hope that the hospital can prepare a special time to file Covid-19 claims and routinely monitor the submission of claims to avoid dispute/pending claims and/or inappropriate claims,” ​​he said.

Ghufron revealed that his party also specifically allocated verifier officers to verify Covid-19 claims and prepare a system for managing Covid-19 claims. This step is a manifestation of BPJS Health’s transparency and professionalism in carrying out special tasks mandated by the government.


Source: Suara.com – Berita Terbaru Bisnis, Ekonomi, Investasi Indonesia by www.suara.com.

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